Time to rebuild trust

I teach applied lung physiology to over 200 first year medical students in the United States. Every year I start the class with a confession and an apology. My students pay $40,000 a year only as tuition. An overwhelming majority of these students finish medical school with an average loan of $200,000.

I confess to my students that I had to spend only $1 for my medical diploma. I explain that I paid a total of Tk.54, i.e. Tk.9 a year, for my medical education. I tell them that the poor people of my country heavily subsidised my education.

I start my class apologising to the poor souls from my beloved country. I tell my students how gratefully these poor people gave their bodies for our medical education. I also confess my failing in not showing any gratitude to those patients when I was a learner, and by escaping my duty to help alleviate their sufferings with the skills I learned with their help.

I tell my students how these poor people helped us learn to diagnose and manage diseases, perform surgeries, put IV lines and do all other medical procedures. I also confess that it never came to our minds that we should say at least a “thank you” to those suffering people, instead we misbehaved with them for silly reasons.

The actions of the internee doctors of Dhaka Medical College hospital saddened and angered me. I did my internship 15 years ago, and even then the general feeling of impunity, unaccountability, ungratefulness, and sense of a communal empowerment was very strong among my fellow interns. We thought ourselves gods within the confines of the hospitals.

We were extremely antagonistic to the idea of accountability to the patients. We could not imagine that we should also be subject to scrutiny. We also did not have any clue that, as service providers, we should be subject to the basic norms of customer service. When a senior police official visiting his sick mother dared to challenge the intern doctor, some outraged interns beat him up and shut down the hospital.

Even during our time, it was fashionable to call a wildcat strike, lock down the hospital and rally against the director. The interns who did not go on strike were ridiculed by interns of other medical colleges as “wimps.”

I remember how we organised boycotts of pharmaceutical companies to press our demand for a dish antenna for the doctors’ hostel, or sponsorship of all expenses paid 4-days Cox’s Bazar trip for 150 interns.

We did all these with pride, without an iota of remorse, even though we were not necessarily bad human beings. Then why did we do all these? We thought of all that we were getting — free education, free accommodation, subsidised food and unlimited supply of patients — as our birthright.

We were never told of the sacrifice that made all this luxury possible for us. We were never taught, not in school, not in college and even not in medical college, that we ought to respect the physical autonomy and privacy rights of every human being. In medical school curriculum there was no ethics education.

Even now, a student graduates from medical school without learning about the patient’s bill of rights. Neither do they see any respect for that during their years as trainee physicians.

I understand the outpouring of anger at the DMCH intern incident. I also understand that if trainee physicians can behave this way, we cannot expect much better from their seniors.

The last remnant of trust that existed between physicians as professionals and the rest of the population has disappeared. The physician community as a whole must take the responsibility for the loss of this trust, and must work to restore it. Until that trust is restored, doctors must be prepared to face angry outbursts of the public after every death under their watch.

It is true that in most cases, especially in the emergency room, a death may well be wrongly attributed to doctor’s fault. There are also many cases where internee doctors go out of their way to help a poor patient.

But the doctor community as a whole must do some soul searching. They must ask why every death is attributed to the doctor? Why, after each death, has the duty doctor to hide from the patient’s angry family?

Physician-patient trust is one of the most sacred bonds in human society, but it has perished in Bangladesh. It’s time to start rebuilding the trust. Let’s start this long and difficult journey by instilling a sense of accountability and gratitude among our trainee physicians. Let’s redesign our medical curriculum to include education on ethics and patient’s bill of rights.